Anterior Cruciate Ligament Rupture
The anterior cruciate ligament (ACL) is one of the major ligaments of the knee joint. It supports our ability to do sudden stops, pivot or changes in direction. It usually occurs after a rotational injury whilst pivoting off the affected leg in sporting activities.
ACL injuries can be treated both conservatively and surgically. The conservative treatment, if suitable involves Cross bracing technique or RICE and physiotherapy designed to strengthen and stabilise the quadriceps muscles and avoiding risky activities involving sudden stops, pivot or changes in direction. However more severe injuries and symptoms of instability will require surgery to replace and rarely repair the torn ligament. The surgery to replace the torn ACL is described as ACL reconstruction.
It is particularly important in younger athletes to have a stable knee. Active patients participating in football, soccer, basketball, netball, tennis and skiing often have symptoms of instability and will elect to proceed to reconstruction. Choice of treatment in older patients is often dependent on their activities of daily living and their sporting and pivoting activities.
The ACL reconstruction surgery has undergone multiple advancements especially in the recent years to better suit the demographic of injured patients and include the following but not limited to
- Graft fixation techniques moving away from traditional screws and staples.
- Graft choices including single hamstring quadruple tendon, Quads tendon graft, Allograft graft tendon and supplementary fixation with internal brace to add strength to the reconstruction surgery.
- Lateral Extra-articular tenodesis (LEAT) is a procedure that may be used to augment a routine ACL reconstruction or revision surgery, to reduce persistent anterolateral rotatory instability. It is being used increasingly commonly due to high quality evidence that it improves graft survivorship in individuals who are at high risk of graft re-rupture.
If you have sustained a knee injury and torn your ACL, your GP or Physiotherapist will decide to refer you to an orthopaedic surgeon to explore appropriate treatment options. We can than assess you to determine the best approach based on your individual circumstance and your suitability for either conservative management of surgical management of ACL reconstruction using advance techniques.